Jul
14
CAN I STILL HAVE SEX AFTER PROSTATE TROUBLE?
This probably will be the most read chapter in the book, and rightly. The prostate is tightly bound up with a male’s manhood, and how he thinks of himself as a man. That’s why even the mention, let alone the discussion, of the prostate and its troubles, make most men uneasy, nervous and embarrassed. We’ll look at all problems with the prostate and how they may or may not affect a man’s libido, his attitude, his sexual performance and his sexual desires.
PROSTATITIS AND SEX
The first problem many men have with their prostate is prostatitis. Symptoms of this involve lower back pain, pelvic discomfort, a burning in the penis when urinating, urinary frequency and sometimes a slight pain after ejaculation. This form of noninfectious prostatitis may be caused by some infectious agent we know nothing about, or by some noninfectious form of inflammation. On the other hand, it also can be caused by a man’s sexual habits — too much sex or too little. During arousal, a man produces four times the prostatic fluid he usually does. If this fluid is not discharged by ejaculation, it remains in the prostate. If this happens often, the prostate can become seriously congested.
To prevent this problem, a normal, healthy sex life is the best course of action. If this is not possible, a massage of the prostate by a urologist will relieve the congested prostate and eliminate the pain. If that’s not desired, masturbation is a quick solution suggested by many urologists. Too much sex, too quickly, say eight or ten ejaculations in a two day period, can overwork the prostate and again cause problems. On the other hand, abstinence may cause a build up of prostatic fluids and lead to congestion so a massage is needed. Coitus interruptus, simply the removal of the penis before ejaculation, is a method of birth control once practiced by millions. If done often enough, and if it stops the man’s climax, this too, can lead to an oversupply of fluid in the prostate and bring about congestion and its symptoms. If coitus interruptus is used frequently by a couple, the man or woman should continue to excite the penis to a normal ejaculation to prevent buildup problems in the prostate. So for prostatitis, which can strike men of any age, sexual intercourse may be both the cause and the solution.
INFECTIOUS PROSTATITIS
This inflammation of the prostate is caused by some type of infection and can cause fever, chills, nausea and vomiting as well as an urgency to urinate, burning, pain and blood and pus in the urine. It’s more serious than the non-infectious type. There may be serious congestion of the prostate and urologists sometimes use a prostate massage to relieve it. Most urologists feel that sexual activity of any type that leads to ejaculation is the ideal way to empty the prostate and relieve the congestion.
BENIGN PROSTATIC HYPERPLASIA
With the enlargement of the prostate there will be some sexual changes, particularly if there is surgery involved. As you may remember, a man will have a normally enlarging prostate for ten to fifteen years, maybe more, before he notices it. The enlargement itself does little to sexual performance with the exception of a seriously pinched urethra that could reduce the amount and force of an ejaculation. When it comes to needed surgery for BPH, the question of sex becomes more important.
First, there should be no sexual intercourse for six weeks after a normal TURP surgery. This is to allow time for the “canal” dug through the enlarged prostate tissue to heal.
On a standard TU RP operation to remove enlarged prostate tissue, about six percent of all men operated on will become impotent. That means they will not be able to have a normal erection. There are bundles of nerves on each side of the prostate, and some of these control the impulses and nerve responses that combine to produce an erection. If these nerve bundles are damaged in any way, impotence can follow. Remember, this six percent figure may not be totally accurate. The figure is based on subjective information supplied by the patient. It wouldn’t be unusual for a man 68 or 70 or older to claim that he could have an erection before the operation, when in reality he had lost that ability due to natural aging or some other problem. It is a factor to consider. The other change in a man who has had a TURP operation is that the bladder neck may have been damaged or removed during the TURP. The bladder neck is like a “valve” that automatically closes when a man is ejaculating. It prevents the fluids from going upward into the bladder. The urethra muscles then force the fluid out the end of the penis. After a TURP operation, the bladder neck may no longer be there or it may be enlarged to such an extent that the fluids of the ejaculation take the path of least resistance, and flow upward a half inch or so and empty into the bladder. When this happens the man has exactly the same physical sensations that he had when the ejaculate emptied out the end of his penis. The feeling, the motion, the thrill is the same, only the path the fluid takes is different. This retrograde ejaculation is almost a one hundred percent probability in a TURP or open surgery for BPH. It’s simply a fact of life. However, with men who usually are in the operative stage, their age is often in the early to late sixties or later, and the lack of a penile ejaculation does not present much of a problem. This is especially true if the situation is carefully explained to the patient and his wife before the operation.
CANCER OF THE PROSTATE
Stage A and B cancer of the prostate will usually involve a radical prostatectomy, the complete removal of the prostate. This almost always harms the nerve bundles on both sides of the prostate and results in a man being impotent. However new techniques have now been developed to preserve these nerves. Some urologists say that in so doing, they may leave some cancer cells behind after the operation. At this point the cancer is the main concern, the life of the patient, and not his sexual function. The surgeon will try his best to get all of the cancerous growth. The nerve bundles are not a high priority. For the man who might be in his fifties, and is cured of a stage A cancer of the prostate, there are drugs and devices that can help him achieve an erection for satisfying intercourse. The cancer patient who is treated with radiation, internal or external, can usually continue his sex life without any problems. His sexual ability would be the same before or after the radiation with the exception of the normal radiation caused fatigue problems. When used in certain areas, radiation can also cause impotence. For the cancer patient with stage D cancer of the prostate, which is usually not operable, the man’s sex life would be in direct relation to where the cancer was situated and how it affected his ability to perform. At this point the patient is much more interested in extending his life, and not worried about his sexual function.
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2
Acne: Hormone Treatment
July 2, 2009 | Leave a Comment
Hormone Treatment
Because hormones, especially androgens like testosterone, play a role in acne, changing the balance of these natural compounds in the body can be helpful in some cases. Many young women benefit from taking birth control pills for their acne. This treatment stops the hormone surges and also probably reduces the amount of testosterone that is available to stimulate oil-producing hair follicles and make mischief. Keep in mind, though, that young women who take oral contraceptives for an extended period may have a lowered libido for quite a long time after discontinuing the treatment. (Parents of teenagers may not consider this a negative factor, but it can be very troublesome for a woman in her twenties or thirties.)
Q. You had a question about a teenage girl with acne. Nothing the dermatologist prescribed had worked, and her mother refused to consider birth control pills for her.
My heart goes out to her. I too have suffered with acne my whole life, starting when I was 10 years old. I am now 35.
My parents took me to dermatologists who prescribed pills and creams; we changed my diet; we tried sun exposure and no sun exposure. They kept trying because they knew my self-esteem was suffering. Acne makes you feel ugly. At the age of 16 I saw a gynecologist who suggested birth control pills. I was raised a strict Irish-Catholic, but Mom was open to anything that might help me. Within 2 months of starting birth control pills, my skin was considerably better! I am one of those people whose body loves the pills. As soon as I stop taking them, my skin starts to break out. I hope my experience will help convince that mother that birth control pills could be the magic she wants for her daughter.
A. Usually Accutane or Cipro are prescribed and they help in the vast majority of cases, but there are minor exeptions due to the individuality of each patient. When all else fails, birth control pills can be helpful. The hormones counteract testosterone. Yes, young women make this male hormone too. Not every woman tolerates oral contraceptives as well as you do, but doctors frequently prescribe them for hard-to-treat acne.
A dermatologist may also prescribe a very old-fashioned blood pressure drug called spironolactone by itself or in combination with birth control pills. This is an “off label” use of spironolactone, but one with quite a long history. Spironolactone seems to help reduce the action of testosterone or other androgen hormones. That may explain why it is also used to treat women who have excessive facial hair (hirsutism). The dose that dermatologists use for acne is usually one-fourth that used for hirsutism.
Spironolactone is a potassium-preserving diuretic and must not be combined with potassium supplements or other potassium-preserving medications. In addition, spironolactone carries a black-box warning in its. prescribing information that tells doctors in the strongest way possible that this drug causes cancer in animal studies. Generally, therefore, physicians prescribe it only for a limited time. Women are urged not to become pregnant while on this medicine. When it is used in combination with oral contraceptives, that shouldn’t be as much of a concern.